EHR Scores in National Football League

CHICAGO -- A new electronic health record (EHR) system and its complementary digital technologies are helping the National Football League assess and care for injured players more quickly, two speakers said here.

"Physicans are not the most rapid group to respond to technological innovations," Matthew Matava, MD, immediate past president of the National Football League (NFL) Physicians Society and head team physician for the St. Louis Rams football team, said Tuesday at the annual meeting of the Healthcare Information and Management Systems Society. "I can see my colleagues and myself getting more comfortable with the system ... it's going to be a learning curve for us too, but I think it's ultimately going to be an improvement for healthcare."

Matava noted that on game day, his job is to first evaluate all 53 players on the Rams with respect to their readiness to play -- either when they're recovering from an injury or to prevent an injury from occurring.

During the game itself, the job of Matava and his assistant surgeons, orthopedic specialists, primary care physicians, and athletic trainers is to "assess each player's injury, triage the injury, and diagnose the problem in a rapid and accurate fashion and then render a treatment plan." Matava noted that there are about 27 medical professionals working at every NFL game, which equates to about one medical professional for every player.

However, Matava and his team can't actually see every injury that occurs, so they use an "eye in the sky" -- also known as the NFL's Injury Video Review System, a video setup high up in the stadium, staffed by certified independent athletic trainers and a replay technician.

"Their job is to spot potential injuries, find us video clips, tag them, organize them, and produce them at the sidelines for review by the athletic trainer or medical staff," explained Michelle McKenna Doyle, the NFL's senior vice president and chief information officer.

Although the system was originally put into place to help spot potential concussions, "it helps me see orthopedic injuries as well," Matava said. "Our job is to triage what body part was injured and determine whether the player can continue to play" or if he needs more treatment.

Having this video that shows the injury has been extremely helpful, according to one of the team physicians that Doyle spoke to about it. "Imagine if you'd been in an accident and you showed up at the emergency room for treatment, you were not only able to tell them what happened, but you were able to hand them a video of the actual mechanics of an injury ... You can imagine how powerful that data can be if it's all linked together," said Doyle.

For players who may have sustained a concussion, the team physicians must determine whether a concussion has occurred and what treatment is needed. Prior to the advent of mobile computing technology, the concussion assessment -- which includes mental tests of memory and processing speed -- would have to be done away from the sidelines, in the locker room, but now it can be done on the field using a tablet computer. The process only takes 5 to 6 minutes, and results can be compared with baseline scores taken earlier for the same test and stored in the player's EHR, Doyle said.

Being able to compare the player's assessment with his baseline score at beginning of the season "has changed our sideline management of this injury in a significant fashion," Matava said. Doyle noted that with the assessment being integrated into the medical record, "you also have [the player's] complete medical history, including the last time this [type of injury] may have occurred."

The EHR the teams are using was adopted two seasons ago and is now in use by all of the NFL teams, Doyle explained. "Unlike a personal [medical] record, this medical record becomes part of [the player's] employment ... all the HIPAA laws and rules that apply to a regular patient record apply [here], but this record transfers around with the player as they are moved not only from physical location to the point of treatment to the training camp to when they're back home, but also when they get traded to other teams, that record has to be able to move with them."

The EHR chosen by the football league "had to be able to integrate with clinical, pharmaceutical, and [other] solutions," she continued. "The integration of multiple facilities and imaging ended up being one of our biggest challenges ... Our goal was to provide a comprehensive record, medical history, and images without delay; they need to be available as soon as possible when treating injuries. Storing the films in a centralized location would not have solved the problem."

The collection of a player's medical record starts at the "combine," a week-long period in mid-February when 320 potential NFL draft picks come to Indianapolis and have six physical examinations, "and at that place we'll get all their records from their college trainer, we'll get every MRI and x-ray we need in order to assess the players' previous injuries as well as their current ability to play, and that will be all incorporated at that time into their [EHR]," said Matava.

Other professional leagues, including Major League Baseball, the National Hockey League, and the National Basketball Association, have all started projects to implement EHRs, Doyle said.

Matava predicted that eventually all major league sports teams will have EHRs for their players. "I think it's going to be inevitable .... Ultimately, a lot of this stuff depends on money to pay for it -- it's an expensive endeavor, but I think eventually it will happen in all sports."

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